Survival and Risk Factor Analysis of Open Wedge Tibial Osteotomy for Medial Unicompartmental Osteoarthritis

Gun Woo Kim; Eun Kyoo Song

doi:10.4055/jkoa.2014.49.6.439

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Kim and Song: Survival and Risk Factor Analysis of Open Wedge Tibial Osteotomy for Medial Unicompartmental Osteoarthritis

Original Article

Journal of the Korean Orthopaedic Association 2014; 49(6): 439-445.

Published online: 30 December 2014

DOI: https://doi.org/10.4055/jkoa.2014.49.6.439

Survival and Risk Factor Analysis of Open Wedge Tibial Osteotomy for Medial Unicompartmental Osteoarthritis

Gun Woo Kim, M.D., Eun Kyoo Song, M.D.

Department of Orthopedic Surgery, Chonnam National University Medical School, Gwangju, Center for Joint Disease, Hwasun, Korea.

Correspondence to: Eun Kyoo Song, M.D. Department of Orthopedic Surgery, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju 501-746, Korea. TEL: +82-61-379-7676, FAX: +82-61-379-7681, eksong@chonnam.ac.kr

Received 28 April 2014 Revised 17 August 2014 Accepted 16 September 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to evaluate the mid to long-term clinicoradiological results of open wedge high tibial osteotomy performed as the primary treatment for medial unicompartmental osteoarthritis of the knee and to analyze the factors that affect the survival rate.

Materials and Methods

The study cohort consisted of 124 patients who underwent open wedge high tibial osteotomy for medial unicompartmental osteoarthritis of the knee and had a minimum follow-up period of five years. Hospital for special surgery (HSS) and the Western Ontario and MacMaster (WOMAC) scores, tibiofemoral angle, mechanical axis of lower limb, medial proximal tibia angle, and tibia posterior slope angle were used to evaluate the clinical and radiographic outcomes over the mean follow-up period of 85 months. The risk factors that affected the survival rate were calculated by multivariate regression analysis.

Results

Mean HSS scores and WOMAC scores showed significant improvements at the final follow-up. The tibiofemoral angle was improved to 8.4 degrees of valgus after surgery. A total of 12 patients (9.7%) failed to survive until the final follow-up resulting in 8 year survivorship of 90.3%. Risk factors significantly affecting the survival rate afteropen wedge high tibial osteotomy included a high body mass index (BMI), severe varus deformity, severe osteoarthritis (Kellgren-Lawrence Grade III or IV) preoperatively and overcorrection angles in operation.

Conclusion

Open wedge high tibial osteotomy showed good clinical and radiological outcomes in the current study. Analysis of the risk factors influencing survivorship after open wedge high tibial osteotomy suggests that the surgical procedure be avoided or modified with patients who have a high BMI, severe varus deformity, or severe osteoarthritis symptoms preoperatively.

Keywords: high tibial osteotomy, medial unicompartment knee osteoarthritis, survivalship

Figures and Tables

Figure 1

The radiographic indices in a knee. (A) Measurement of tibiofemoral angle. (B) Measurement of mechanical axis. (C) Measurement of medial proximal tibia angle. (D) Measurement of post slope angle.

Figure 2

Kaplan-Meier survivorship analysis (with 95% confidence intervals) for all high tibial osteotomies.

Table 1

Characteristics of Patients Enrolled in the Current Study

Values are presented as mean±standard deviation or number only.

Table 2

Risk Factor Analysis after High Tibial Osteotomy

^*We executed multivariate analysis regarding limited to significant factors such as BMI, mechanical axis, tibiofemoral angle and correction angle which are p<0.05 on univariate analysis. ^†This mark indicates categorical value. BMI, body mass index.

Table 3

Comparison of Survival Rate for High Tibial Osteotomy

^*This mark indicates 8-year survival rate.

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